Wednesday 23 January 2019

Dear Dr Nina: Severe hay fever is spoiling my summer, and antihistamines don't help


Nina Byrnes

I've been suffering in the good weather from horrific hay fever. I never had it growing up but it came on in my mid-twenties. I'm now nearly 40 and every day in the summer I wake up with a scratchy throat and spend the day sneezing and rubbing my eyes. It can get really miserable. I work as a cleaner and the chemicals I use set it off as well, but I don't want to open the window because of the pollen! I have used antihistamines in the past but I have found that they don't really help. Please help.

Dr Nina replies: The symptoms of hay fever are a response to exposure to an irritant or allergen. The immune system responds by releasing histamine, a chemical that has a myriad of effects. The most common allergens for seasonal sufferers are grass and tree pollens, with weeds, moulds and fungi also playing a role. 

Other irritants such as exposure to fumes and exhaust can often add to the problem and as a result many urban dwellers suffer more. Avoiding most of these substances is virtually impossible, so for many people finding a way of controlling their symptoms becomes an annual crusade. There is no medical cure for allergic rhinitis but is it is possible to hit each symptom and so a combination of remedies often works best.

Treatments are most effective if started before symptoms start. I recommend starting medication around St Patrick's Day. Antihistamine tablets block the release of this hormone and can be very helpful. The older ones can be very sedating and must be taken several times a day so the newer, less-sedating once-daily tablets are probably a better choice.

The next weapon in the medical armoury is a steroid nasal spray. These take a few days to kick in and are designed to be taken daily through the season.

The third treatment is eye drops. Itchy, red eyes are often a very distressing symptom and the regular use of the correct drops can bring great relief. Lastly, nasal rinses are now recommended to help reduce the presence of allergens in the nasal passages.

Allergies can disrupt sleep, but there are a few things you can do to get a more restful night.

Take a close look at your bedroom. You should remove any carpets or rugs, as these trap dust. Don't allow pets to sleep in your room. Use hypoallergenic sheets and bedding and change them weekly. Don't dry your bedclothes on the line. Air-dried sheets may seem appealing, but they act like a pollen trap that ultimately ends up on your bed. Vacuum your mattress and pillows regularly using a HEPA (High-efficiency particulate arresting) filter. Get rid of old pillows and mattresses. These can be home to millions of dust mites, which will make allergies worse. Changing your bedding can make a difference. Look for hypoallergenic mattress fillers.

Try to keep windows and doors shut to limit the amount of external pollens entering your home. Pollens peak in the early hours of the morning so windows left open at night will ensure you get a good blast of these. Keep them closed. Use fans or an air conditioner with HEPA filter to keep the house cool.

It's also a good idea to take a shower before bed. This will remove any allergens or pollens from your hair and skin. Dry yourself with a dryer-dried towel and dress in dryer-dried bedclothes.

Have a warm drink before bed. The steam may help partially soothe and clear your sinuses. There are ointments and oils available that help keep nasal passages clear. Applying those to your pillow or chest can help. You may not be able to cure your allergies, but following the above simple steps can help.

Q. I tripped in the kitchen a week ago and landed awkwardly on my right hand. My little finger is still swollen and painful. Could it be broken, and if so do I leave it alone or see my doctor?

Dr Nina replies: The hand is a complex structure containing many bones, tendons and ligaments. Injury to any part of the hand or its structures can lead to pain. Trauma or injury is one of the most common causes. Falling awkwardly onto your hand can certainly lead to a fracture. If there is a broken bone, you will usually experience notable swelling, bruising and possible reduced movement of the area involved.

Hands tend to swell when injured and as we hang our arms down, swelling can take longer to settle, as it has to go against gravity. Swelling of the fingers is also painful as there isn’t a lot of space to absorb the excess fluid, therefore, pressure on nerves and blood vessels occurs quite easily. Keeping the hand upward can help reduce swelling and pain. If the pain and swelling remain severe, X-rays may be appropriate.

Treatment required depends on which, if any, bone is broken and how stable or unstable a fracture may be. Simple fractures of the hand are often treated by simply ‘buddy strapping’ one finger to another for three to four weeks. More complicated ones may require surgical reduction and splinting. An X-ray would help decide which treatment is warranted.

Pain that persists despite normal X-ray is most likely due to inflammation or sprain. It is not unusual that your finger is still sore and swollen one week later. Simple sprains can take six or more weeks to heal. Pain should ease in the short term, but with hand injuries some swelling can persist for a long time. Physiotherapy or finger strapping and splints can help in some cases. Exercises may be prescribed to help improve the function and strength of strained ligaments and tendons.

If you have any health queries for Dr Nina Byrnes, please email Please note that Dr Nina cannot enter into individual correspondence

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